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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 April;41(2):215-9

lingua: Inglese

Pre-existing elevated pulmonary vascular resistance. Long-term hemodynamic follow-up and outcome of recipients after orthotopic heart transplantation

Tenderich G., Koerner M. M., Stuettgen B., Mirow N., Arusoglu L., Morshuis M., Bairaktaris A., Ninami K., Koerfer R.

From the Department of Cardiovascular Surgery Heart Center North Rhine-Westphalia University of Bochum, Bad Oeynhausen, Germany


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Background. Elevation of pul­mo­nary vas­cu­lar resis­tance (PVR) has ­been con­sid­ered to pre­dict a bad out­come ­after ortho­top­ic ­heart trans­plan­ta­tion (HTx). A trans­pul­mo­nary gra­di­ent (TG) ≥15 mmHg and PVR ≥5 ­wood (w) are cor­re­lat­ed ­with a ­three-­fold ­increase in 2-­days as ­well as 30-­days and 6-, 12-­month mor­tal­ity.
Methods. We per­formed a ret­ro­spec­tive anal­y­sis of 400 con­sec­u­tive trans­plant­ed ­patients (pts) on hemo­dy­nam­ic ­data ­over a ­time peri­od of 3.5 ­years. In 83 pts (23%) pre­op­er­a­tive PVR was ≥5 w and TG >15 mmHg. Vasodilator stud­ies ­were per­formed in ­this ­group of pts in ­order to eval­u­ate pul­mo­nary vas­o­reac­tiv­ity or hemo­dy­nam­ic improve­ment.
Results. Hemodynamic fol­low-up ­post-trans­plan­ta­tion ­showed a sig­nif­i­cant (p<0.001) ­decrease in ­mean TG to 8.8 mmHg with­in the ­first, 7.7 ­after the ­fifth ­year as ­well as ­decrease in PVR ­from 5.5 to 1.6, with­in the ­first and ­fifth ­year ­post-trans­plan­ta­tion. Compared to the con­trol ­group (n=286) (re-trans­plants n=6 and pedi­at­ric pts n=25 exclud­ed) pts ­with TG <15 mmHg and/or PVR <5 w, trans­plant­ed with­in the ­same peri­od, 30-­day mor­tal­ity and cumu­la­tive sur­vi­val ­after 1 and 5 ­years do not ­show any sig­nif­i­cant dif­fer­ence ­with a mor­tal­ity of 3%, 22% and 33% (p<0.05). Subgroup anal­y­sis for pts ­with end­stage of ischem­ic ver­sus dil­a­ta­tive car­di­om­yo­pa­thy has not ­shown any sig­nif­i­cant dif­fer­ence in mor­tal­ity.
Conclusions. In a ret­ro­spec­tive anal­y­sis of 400 pts ele­vat­ed PVR ­does not pre­dict a bad out­come ­after ortho­top­ic ­heart trans­plan­ta­tion in ear­ly and ­late mor­tal­ity.

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